Rehabilitation Plan and Award

ICR 201403-1240-003

OMB: 1240-0045

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2014-04-22
Supplementary Document
2014-04-22
Supplementary Document
2014-04-22
Supplementary Document
2014-04-22
Supplementary Document
2014-04-22
Supporting Statement A
2014-05-28
IC Document Collections
IC ID
Document
Title
Status
13717 Modified
ICR Details
1240-0045 201403-1240-003
Historical Active 201011-1240-005
DOL/OWCP
Rehabilitation Plan and Award
Revision of a currently approved collection   No
Regular
Approved without change 09/15/2014
Retrieve Notice of Action (NOA) 07/15/2014
  Inventory as of this Action Requested Previously Approved
09/30/2017 36 Months From Approved 09/30/2014
4,590 0 5,500
2,295 0 2,750
0 0 0

Form OWCP-16 is used by vocational rehabilitation counselors to submit an agreed upon rehabilitation plan to OWCP for approval, and documents OWCP's award of payment for any approved services.

US Code: 5 USC 8101 et seq. Name of Law: Federal Employees' Compensation Act (FECA)
   US Code: 33 USC 901 et seq Name of Law: Longshore and Harbor Workers' Compensatinon Act (LHWCA)
  
None

Not associated with rulemaking

  79 FR 17193 03/27/2014
79 FR 41305 07/15/2014
No

1
IC Title Form No. Form Name
Rehablitation Plan and Award OWCP-16 Rehabilitation Plan and Award

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,590 5,500 0 0 -910 0
Annual Time Burden (Hours) 2,295 2,750 0 0 -455 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Over the last three fiscal years (FY 2011-2013), open rehabilitation cases have averaged 4, 590, which is 910 less than the number reported (5, 500) for the previous submission in 2011. As a result in reduction in Rehabilitation Plans, burden hours have decreased 455 hours, from the previous submission of 2,750 to 2,295. As previously indicated in item 12, there are no costs for burden hours as the respondents are contractors and are remunerated for their services and expenses by OWCP. Revisions of the form itself include the following changes: The form was expanded to two pages to allow for more sufficient space to complete it. Additionally, in item 15 of the form, the reference to the District of Columbia Compensation Act was removed as the DC government is responsible for administering their own program. This was previously administered by Longshore. Additionally, an accommodation statement was placed on the form to inform claimants who have mental or physical limitations to contact DFEC if further assistance is needed in the claims process. Finally, the Privacy Act and the Public Burden statements were revised.

$204,826
No
No
No
No
No
Uncollected
Marcus Sharpless 202 693-0998 sharpless.marcus@dol.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/15/2014


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